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The below guidelines can decrease length of stay and facilitate discharge to acute rehab facilities sooner. Place Physical Medicine and Rehabilitation (PM&R) consult early on these diagnoses: spinal cord injury, stroke, amputations, brain injury.
Medical Readiness Guidelines
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In addition to a patients medical clearance, it is important that the following are in place:
- Patient has the potential to tolerate and participate in three hours of daily therapy
- Accepting facility can manage patient’s medical needs
- Follow up appointments and upcoming diagnostic testing should be scheduled after discharge from rehabilitation (unless approved by accepting facility).
Medical Status
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- Work-up completed and treatment plan agreed upon by primary and consulting services
- Agreement of discharge readiness among consulting services
- No active psychiatric issues that would prevent participation in rehabilitation program.
- Sitter / 1:1 should be discontinued prior to transfer
- Dialysis cannot be provided for patients under age 18
Treatment & Lab Data
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- LVAD may be admitted after all equipment and batteries issued
- Documented Weight Bearing Status, orthopedic or spinal precautions
- Blood product transfusions no more than three times per week
- No telemetry monitoring
- Stable labs values, requiring lab draws no more than two times per week
Respiratory
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- Suctioning needed at a maximum frequency of every four hours
- Respiratory treatments maximum frequency of every six hours
- O2 per nasal cannula 4 LPM or less
- O2 per trach collar FiO2 40% or less
- Two caregivers should be identified for vented patients
Medications
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- No PIV medications, except IV antibiotics with PICC line
- No IV chemo medications; oncology plan to be established prior to discharge. No radiation therapy
- Established anticoagulation/DVT ppx, if age appropriate
- IVIG after initial dose must be approved 48 hours prior to transfer
Diet
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- Oral diet or able to tolerate tube feeding to provide caloric and fluid requirements
- Gastrostomy tubes recommended. NG/NJ tubes accepted on a case by case basis
- TPN patients need to be on a stable solution for discharge to home on TPN
Infection Control
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- No active TB
- No airborne/droplet precautions
- Isolation protocols vary by diagnosis at Shirley Ryan 小恩雅, secondary to rehabilitation outside patient rooms
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These are guidelines. For more information, please speak with your Shirley Ryan 小恩雅 liaison or consulting physician.